This post was authored by Robert N. Vincent, MD, CM, FACC, chair of the IMPACT Registry Steering Committee

The ACC’s IMPACT Registry is a vehicle to collect data on all pediatric patients and adult patients with congenital heart disease undergoing diagnostic and interventional catheterization procedures.  First and foremost, its key objective is to collect data to identify variability in procedures amongst institutions and operators, link variability to outcomes, assess performance, provide benchmarks and implement quality improvement initiatives.  Specifically, the intent is to improve the care and outcome of patients with congenital heart disease undergoing cardiac catheterization.  It is meant to be used internally to help institutions and operators identify areas for improvement and institute practices to improve outcomes. 

Reports consisting of the last 12 months of data are distributed quarterly to participating institutions. These reports contain center specific data as well as aggregate data for all metrics and data elements. Individual institutions are therefore able to compare their data and outcomes to aggregate data, but not to other specific institutions.

How institutions evaluate their reports internally will vary, but without a specific, defined process, the goal of quality improvement is unlikely to be achieved. We recommend centers consider the five “W’s” listed below when evaluating the quarterly report.

Who: Who is looking at them? Is it just one person or a committee? Is everyone involved in the cath procedure present for discussion, or is it just an administrator looking at the data and being happy if metrics are met? Unless all involved personnel are present (physicians, nurses, technicians, administrators, etc.) and active in the discussion of the report, there won’t be a meaningful discussion about quality improvement. Good data are dependent on good data entry. Who is responsible for data entry and data oversight?

What: What are you looking at? Are you just looking at the quality metrics or are you looking at all aspects of the report? Are you analyzing what these numbers really mean to you and your institution and do they really reflect what is happening within your institution? Are the data correct or have there been data entry errors? They can be fixed. If you identify a problem within the registry outcomes report that you think results from a programming issue, this needs to be relayed to the NCDR.  Hospital feedback enhances the quality of reporting.

When: Are there regularly scheduled meetings and do all interested parties attend? Is there really a discussion and exchange of ideas or is someone just reading the report? Are you comparing your results to previous results and looking at areas with declining performance as well as areas showing improvement, or are you just content if things look alright compared to benchmarked data? The intent of having a regularly scheduled meeting is to always keep quality on everyone's mind. Participants should be looking forward to seeing data in terms of looking for improvement, not dreading a report showing below expected outcomes.

Where: Is there a place where this meeting takes place that has access to all information needed for discussions that might occur? It is important to have access not only to the quarterly report, but also to your electronic medical records and quality score cards, as well as catheterization, computed tomography, echocardiogram, magnetic resonance imaging reports and images, etc. When questions about specific issues are raised, are you somewhere where you can retrieve the information to answer them?

Why: Why quality improvement? The answer should be to provide patients with the best cardiovascular care possible. If there is no impetus to analyze the data with the intent of trying to improve, then there is little reason to collect the data. You should be comparing yourself to aggregate data for benchmarking, but more importantly to yourself for improvement.

It is not uncommon for centers to look at the data, compare themselves to the benchmark, see that they fall within the expected ranges, and be happy with that. An alternative is to pick one or two areas that you wish to improve upon and analyze these internally (with every report) to see how you are doing. Quality improvement occurs over time and must be evaluated along a continuum. It is only through time that these data become reflective of what is truly happening in your institution. This is particularly true of rare events that occur in uncommon cases (which are the majority of the cases that we do in congenital cardiology).

For more information about the IMPACT Registry and the quarterly reports, visit NCDR.com/IMPACT.

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